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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..........-f" .�1'J... Permit No. ................... 37 tCompleta in Triplicate) 1 ..._aY... .daa .......... ..................... .. .. ............... This Permit Expires I Year From be#*issued Date Issued -. .. Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work heroin; described. This application is made in compliance with County Ordinance No. 549 and existing..Rules and Regulationst JOB ADDRESS/LOCATI 2... e.1 _.....,. / CENSUS TRACT .......................... 7 Owner's Name .. ---•--- ...Plane .................................... ..... rtCi . ..Address 9 Contractor's Nome _. msLicense # Phone .. installation will serve: Residence[gAportment House Commercial OTroller Court 0 Motel[j Other............................................. Number of living units:..../... Number of bedrooms .Garbage Grinder ..._._ Lot Slze ... ...... Water Supply: Public System and name ....... /z� .... k� ' ...............................................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt Q Cloy D Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe rky Fill Material ............ if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONt-- (No septic tank or seepage pit permi sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ j E/V-S 7-iz :t�------------------------------------------ Liquid Depth ..........................0 Capacity ------------ ....... Type .................... Material............... ...... No. Compartments .......----...........--' Distance to nearest: Well ....... ......... ....... .....Foundation ................... Prop. Lire ........ ...________-_. LEACHING LINE r\' No. of lines .......-1........_____ Length of each Ine.__. . ........._.. Total Length ...��%_............... 'D' Box .../..... Type Filter Material - -. Depth Filter Material ..1.97r.`......:...................... Distance to nearest: Well .JZ;............... Foundation ...All. ........ Property Line :a..... ........... SEEPAGE PIT Depth ........... Diameter, ......... Number .....�:............... Rock Filled Yes A' No . Water Table Depth '•..-•• •..........................Rock Size ...--.7....................... Distance to nearest: Well j _.•......................Foundation __lk...... Prop. Line ..::5__._..:f..._. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. y Septic Tank (Specify Require+ients) ..::.:. .. .. .....__. _... .......s_.... Disposal Field (Specify Requireme l ` .. ...:.--•- -••�-•- • - _------ ` � r/ft ............. ----------------- ............ cam: . ---- - . . -•-•- •---------------------------------•--- --------------------.-------------------------------------------------............................................................. .............................. (Drow existing and required addition on reverse side),, I hereby certify that I have prepared this application and that the work will be don* in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home ownw or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ............ :..... ...... Owner BY �'t.�:.�_ Title.-..... .5-. � ?'.._ �_..._... , (r4�ih�er hanowner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- --------- ......... -- DATE .--. .-:7�?'�{-- -_.._ BUI ING PERMIT ISSUED ----• -- -- --------------------........ ------•-•--- .....-----DATE ----..... ...... " .............. AQ COMM •-•--• _ -. _ . - �.: .. �.. ,..... .. �. . _ �,,�Y �.. .... ........ ---- -------- Fina Inspection by.. ..._.. .._._...-- -•-•• . . ........ .. ........ ..........Date ... -��.��.. .. ---•-•- EH 13 2h 1-68 JO QUIN LOCAL HEALTH DISTRICT $ 6�3M